Yari has questions for Douglas D. Koch, MD: Offering premium lenses with confidence

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Hi, I'm Yari, and I have questions. And this is Dr. Doug Koch, and he has answers. Let's see if they match! Hey Doug, thanks for joining me today.
Hey, Yari, well, this is so fun. I'm looking forward to this, I think.

You think? Don't worry, don't worry, it'll be a super fun conversation. Because I have questions about something I think you might be a pretty big expert in, and that is Premium Technology. I have questions about how we can bridge the gap between the obvious need the patients have for being able to see across a range of vision, being able to function in their daily life, but we're still stuck at low adoption rates. So, I wanted to start with a question. What's your approach to patients? Are you offering Premium Technology to everybody that qualifies? Do you have criteria? What's your approach to patient conversations?

Well, that's a great question. premium technology falls into two categories: Torics and presbyopia-correcting. And for every one of my patients, if they have astigmatism, I mention torics, and for every patient, I mention premium presbyopia-correcting lenses. And the reason I mention that is because they may have had someone near them who's gotten it. And even if they're not a candidate, they would be very disappointed if they thought they might've been a candidate and I didn't bring it up. And you can never judge a patient by how they come in, how they look, where they are, etc. For some patients, despite everything you might think about them, they love this technology, and they want to embrace it. So, you need to bring it up with all.

Have you found in your conversations with patients — Is there any sort of way that you approach talking to them about the benefits that they'll receive with the technology? Why should they invest in their vision with this, you know, correction or opportunity? Is there any language you use in particular?
I try to keep it very simple for patients. I tell them that we have technology that can get them largely, or sometimes, completely free of using glasses. But the problem with that is that it does create some glare and starbursts at night. The beauty of that is that they avoid bifocals, so there's safety in terms of steps and curbs, and freedom from glasses is a wonderful option.

Now what about — So that's your conversation and you understand everything in depth. What about the rest of your team and your practice that are interacting with patients? I'm sure they'll get questions from them as they are, you know, engaging with them throughout the workup process. You know, how do you ensure that your team is on the same message that you are when you talk to patients?

Well, our team does, I think, see the benefits of these technologies, but really all the counseling is done largely by me. I have a boutique kind of practice. I am typically doing 75, 80% torics or presbyopic-correcting every surgery day.

Wonderful.

And that's because I spend that upfront time with patients. I introduce it at the first visit, and then I give them a little brochure that I've written that talks about the technology. And then when they come in for their pre-op visit, which is a separate time, they've had a chance to digest it, they of course all conduct an intense search with Dr. Google, and they come in informed largely. The ones you worry about are the ones that come in with huge expectations, but they really haven't done their work. They haven't read the material; they haven't thought about it. And so, they come in with a kind of pie in the sky attitude and those are the ones that are the challenge in terms of educating and making sure we guide them in the right direction.

Yeah, any pearls there? I mean, I'm sure everyone's running into that situation.

Yeah, you know, sometimes I have to just sort of say, "You know, I think we can't really make a final decision now. You need to think about it some more. Talk with family." And it's really important, in my experience, to have family in the room. Because the family in the room can hear about the benefits, but they can also hear about the pluses and minuses. And it's a much more informed conversation, and the patient can go home and talk about it with educated family members. Which I think is huge.

That makes sense. Yeah, I mean, we all love to go to our networks of people for information to help with decision making. You know, that's so important to have somebody in there so they hear the same information. Or at least hopefully, they hear the same information.

I had it happen this last week, where I had operated on the wife many years ago, the husband was there, he was an engineer. He was leaning toward maybe an EDOF, and his wife kept reminding him, "But you really wanted to be able to read up close." And he was Chinese, he wanted to read Chinese writing. And she said, "You really want to do that?" And so, we went with extended range of focus, Synergy in this case. And sure enough, he's J1+ and thrilled.

That's great and so interesting. Sometimes we don't know ourselves as well as other people around us who observe us.

Right, right, exactly.

Yep, that's great. Well, I love all these pearls. Is there any, you know, advice you would give to your colleagues that maybe are not at that point where they are comfortable and confident to offer premium to every patient like you are? You know, any advice you would give to those that are wanting to grow their business, grow their offering for patients, but maybe aren't quite there yet?

That's a great question. I think the biggest hurdle for most people is having that level of confidence in the accuracy of their calculations. Because all of these lenses really require precision biometry, precision surgery. And the other thing that you have to really kind of embrace and accept is that there are going to be patients you're going to have to take these lenses out of. Not torics, but presbyopia-correcting. They're not going to like quality of vision; they're not going to like the glare or halos. So that's also part of my conversation with a patient. "You know, there's always a chance I'll have to take this lens out and put a different one in." Sometimes, you don't know unless you try it. And if you're comfortable learning about IOL exchange, particularly if it's done within the first 3 to 6 months, it's not that big a challenge. And nailing your biometry, doing the extra measurement, optimizing the ocular surface, that goes a long way. Because offices really get — it's a downer for an office when your own presbyopia-correcting patient comes in really unhappy. It affects everybody in the office.

Absolutely.

And for some physicians, and staff, two or three of those in a short period of time is like, "I'm done." And I think that we have to kind of make sure we improve what we do to the extent that that doesn't happen.

But also, don't get stuck in that moment, right? That's one patient, that's one moment, learn from it, and then you know, continue to push forward.

Exactly, right. Exactly right. And learning how to handle that patient, embrace that patient's unhappiness, accept it, nurture that patient, spend that extra time. That patient on the next go-round could be your biggest advocate.

Yep, I love it. Oh, this has been such a great conversation. I have one final question for you. It's going to be my hardest hitting yet. So, brace yourself. Who's your phone-a-friend? Who do you call when you have tough decisions to make around patient care?

I guess the ones, the people I call are my partner, Mitch Weikert. He would be my number one on my list. Some of my other partners, Sumitra Khandelwal, Bowes Hamill, Allison Chen, Masih Ahmed, I have these amazing partners who have a varied experience as well in all this technology and I have such faith in their opinions.

That's great, our partners are so important. Thank you, Doug, so much. I think you did a great job answering my questions. I learned a lot. I hope all of you feel the same. Thank you so much for joining us.

Thank you.